This invention relates generally to a method and system for utilizing management effectiveness, and more specifically to a method and system for providing medical care at a reasonable cost for all the nation's citizens. Existing tools, which focus on single measurement parameters in isolation, do not convincingly capture the way health care facilities operate. At least in part for this reason, such tools have failed to inspire significant practice pattern changes and/or management efficiencies, even in light of the current furor over U.S. health care spending. Therefore, we designed and developed a method and system of integrated medical organizational performance across the parameters of quality, cost, and access. Without a complete understanding by medical managers of these underlying issues of medical care, solutions to the medical problems of this country are not achievable. Large scale improvements in the current state of medical care require a standard which compels management's attention to the proper balance between these competing but interrelated forces.
The task of evaluating the factors of quality, cost, and access in such a manner as to provide a holistic description of the effectiveness of medical treatment data, is alleviated, to some extent, by the systems disclosed in the following U.S. Patents, the disclosures of which are incorporated herein by reference:
U.S. Pat. No. 5,128,860 issued to Chapman
U.S. Pat. No. 5,117,353 issued to Stipanovich et al.
U.S. Pat. No. 4,992,939 issued to Tyler
U.S. Pat. No. 4,975,840 issued to Detore et al.
U.S. Pat. No. 4,893,270 issued to Beck et al.
U.S. Pat. No. 4,858,121 issued to Barber et al.; and
U.S. Pat. No. 4,667,292 issued to Mohlenbrock et al.
The patent to Mohlenbrock et al. discloses patient billing for hospital care. The computer billing is reviewed by the physician each day. The patent to Beck et al. discloses a medical information updating system for patents. The patent to Tyler discloses a method of producing a narrative report. The Tyler system analyzes information which has been inputted to a database and using predetermined phrases intermingled with extracts from the database, produce a narrative analytical report which describes the critical aspects of the database. The Tyler system also produces a listing of questions on those aspects of the database which require explanation of clarification. The patents to Barber et al., Detore et al., Stipanovich et al., and Chapman are of interest, but they do not model medical care facilities (MTFs) based on quality of care, cost, and access.
Currently, medical care is not evaluated in a holistic manner. Instead, quality is examined in isolation from cost and neither of these is compared to access which is rarely, if ever, evaluated. In addition, there is a lack of commonality between the evaluation criteria that do exist, making comparisons between treatment facilities and medical practitioners infeasible. As a result, goals for improvements in medical care cannot be established except in individual hospitals.
In terms of cost, there are many criteria that are used, whether for the cost of supplies or provider charge rates. Since none of these cost criteria are universal, it is difficult to compare different hospitals on the basis of cost. Also, accounting practices differ causing further complications. To make medical care affordable for all people in this country, it is imperative that definitions of cost be standardized.
Quality of medical care is almost universally defined in terms of mortality rates, which has not proven to be very useful. At least one study has indicated that even the best hospitals can now and then have unfavorable mortality rates. When using mortality figures to evaluate quality of care, it is important to separate those that were expected to die from those that were not. This is not currently done and is not easy to do, especially in terms of the litigation such a practice would cause in insurance and medical industries (i.e. lawsuits over those persons that should not have died). As a result, mortality in and of itself does not describe "quality" medical care and is not a useful metric to use to try to solve the medical problems facing this country.
Access to medical care is not directly measurable. Since there are many hospitals and medical practitioners from which to choose, at least in urban areas, it would be infeasible to attempt to associate the number of people that should have access to a particular hospital or doctor. The only "measurable" criteria for access to medical care are media accounts and government estimates of people who have little or no medical insurance and thereby are assumed to have a lack of access to medical care. Again, definitions are important since medical care is available, its just that people cannot afford it.
To assess how well a hospital or doctor provides medical care, and to establish the cost effectiveness of that care, the three factors of quality, cost, and access must be evaluated simultaneously. Current methods of measuring these factors are lacking and provide little useful information to the medical manager. Without an overall perspective of how these factors interrelate and how an improvement in one can lead to a change in another, medical managers cannot be expected to achieve improvements that would lead to a cost effective medical care program for everyone in the country.